When deciding on a hotel or restaurant, you’ll likely select the option with a high star rating from a trusted source. Seniors can apply the same approach if they want a private Medicare plan.
For the third year in a row, the BlueCross Medicare Advantage PPO plan* – which includes routine hearing, vision and dental coverage – has earned an overall 4-star rating from the Centers for Medicare and Medicaid Services (CMS).
CMS created a ratings program with 50 different measures to improve the quality of health outcomes for Medicare beneficiaries. Through customer satisfaction surveys and review of plan operations and clinical quality outcomes, these measures look at everything from operational efficiency to member engagement (getting recommended care and screenings) to customer service. The measurement scores are tallied for a final score that’s issued every year in October.
The key to earning a 4-star rating is continuously improving how we help members achieve better health.
- Implementing programs that encourage Medicare Advantage members to get CMS-recommended care and tests. More than 98,000 gaps in care have been closed so far in 2017.
- Providing personal service to help members schedule checkups or, if unable to get to a doctor easily, receive assessments from the comfort of their homes.
- Working with providers on value-based reimbursement programs that make it easier for physicians to identify the preventive gaps in care for their patients.
“It isn’t just waiting for calls; it’s being interactive,” says J.B. Sobel, MD, vice president and chief medical officer of Senior Care at BlueCross. “We’re all very engaged when connecting with members. We do health fairs in communities throughout the state. We have in-office days with provider offices to get screenings done for members. We’re working one-on-one with our members to help them schedule appointments with their doctors. It’s all about facilitating that connection.”
Strength in numbers
On 15 of the measures – including customer service and customer retention – BlueCross earned five stars from CMS.
Member satisfaction drives the decisions we make – it’s one of the reasons J.D. Power ranked us “Highest Member Satisfaction among Commercial Health Plans in the East South Central Region.”
Our members know that when they call BlueCross, they won’t be dealing with a person on the opposite end of the country or overseas – they’ll speak directly to someone in Tennessee. In addition to knowing where our members are, representatives from our customer service team are often familiar with certain doctors, practices and pharmacies, as well. This helps quickly establish a connection and sense of comfort, allowing our team to get to the root of an issue and resolve it quicker.
“We’re dedicated, and we’re here,” Dr. Sobel says. “We try very hard to put ourselves in the shoes of our members, to imagine ourselves relying on the support of a program like Medicare Advantage – or to think of our mothers and fathers. The team tries to the furthest extent possible to do the right thing and talk to members the same way they would to a family member.”
Medicare members who have insurance through BlueCross may have coverage that’s controlled by Medicare itself, but we act as the primary advocates for their health and wellness.“Medicare says, ‘OK, BlueCross, if we are going to let you take care of our Medicare members, you have to do it right,’” says Karen Walters, manager of operations in Senior Care at BlueCross. “Our piece in all of this is to be a trusted partner and make sure that we are doing everything we can possibly do to keep these members healthy.”
How we achieve superstardom
Doing everything we can means not burdening our customer service team with a quota on the number of calls they’re expected to take per hour, day or week. The success of our team is gauged by the quality of their calls, and what they did while taking them.
“It’s one member at a time,” says Lauren Garland, customer service expert in Senior Care at BlueCross. “For instance, if there’s an insulin or medication issue with a member and it takes us two hours to resolve their issue – which doesn’t happen often – then it takes us two hours. We’re not going to rest until the issue is resolved.”
Adds Brian Oney, operations supervisor in Senior Care at BlueCross, “We’re not a call center, we’re a care center. And you can’t call yourself a care center if you say, ‘Lauren, you’ve got to take 100 calls today.’
“We’re not comparing the amount of boxes checked; we’re looking at productivity one call at a time.”
There is no set script our customer service team follows; each representative builds their conversation around the member on the phone by following these steps:
- Step 1: When a member calls, we ask what we can do for them and listen before we ask anything else.
- Step 2: Once we learn their reason for calling, we ask permission to gather the information we need to access their account. This is where Health Insurance Portability and Accountability Act verification comes into play; while vital to these calls, we don’t want to bog down the process or potentially confuse the member right off the bat with legalese.
A true care center also recognizes that our members have needs that extend beyond the initial call. Many of them are looking for reassurance or just to know that they’ve been heard and won’t be forgotten.
“A huge part of that customer retention rating is using our judgment to determine when it’s best to follow up with a member after we’ve resolved their issue,” says Kelly Peterson, customer service expert in Senior Care at BlueCross. “I make it a point to tell a member that I’m going to follow up with them on X date, and I place it on my calendar while on the phone with them to ensure that will work with their schedule.”
This constant contact often builds strong relationships.
“One member’s wife was terminally ill, and they were having issues with a claim,” remembers Mary Jones, technical team expert in Senior Care at BlueCross. “His dream was to build her a new home, and he was worried about this unpaid claim affecting his credit. I would call him at a set time, every Tuesday at noon, to provide an update. Once we resolved and paid the claim – on a Thursday, but I couldn’t wait until Tuesday to call – we shared a little crying moment. These are the kinds of connections we make.”
Not content to stargaze
While we thank our members for making these ratings possible – and believe that at the end of the day, these great scores belong to all of us – our work is never done.
“One thing that’s true of these star ratings is that your performance next year is not guaranteed,” Dr. Sobel says. “We’re always doing everything we can to improve as a company, to better meet the needs of our members and increase our outreach efforts.”